Thomas Dow, D.C., P.C. v. New York Cent. Mut. Fire Ins. Co.
This case involves an appeal from an order of the District Court of Suffolk County concerning a provider's action to recover assigned first-party no-fault benefits. The defendant, New York Central Mutual Fire Ins. Co., moved for summary judgment, asserting that the amount sought by the plaintiff exceeded the workers' compensation fee schedule. The District Court initially denied this motion, citing the defendant's failure to establish timely denial of claims. However, the Appellate Term reversed this decision, finding that the defendant had indeed timely mailed its denial forms and made a prima facie showing that the charges were in excess of the permitted fee schedule. The plaintiff failed to provide admissible evidence to counter the defendant's fee schedule defense. Consequently, the Appellate Term granted the defendant's motion for summary judgment.